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Diabetes In Pregnancy

What Causes Diabetes During Pregnancy?

Last updated on:
08/11/2013

Contributing Author: Guy Slowik FRCS

Glucose, a sugar that results from the digestion of food, is the body's main nourishment. During pregnancy, your body also supplies your baby with glucose, which is delivered through the placenta and is your baby's only source of nourishment.

The placenta also makes certain hormones to help the baby develop. But these hormones make it harder for your body to use insulin. About halfway through pregnancy, the placenta increases its production of these anti-insulin hormones.

If your body makes too many anti-insulin hormones, they can block the movement of glucose from your bloodstream into your cells. This is called insulin resistance. At the same time, your pancreas may not be able to produce enough insulin. When too much glucose builds up in your bloodstream, diabetes can result.

Who Is At Risk?

Several factors increase your chances of developing diabetes during pregnancy. These include:

  • A family history of diabetes
  • Previously giving birth to a stillborn baby or to a baby weighing more than nine pounds
  • Obesity
  • Being over age 25
  • Being African-American, Native-American or Hispanic

How Do I Know If I Have Diabetes?

Gestational diabetes has no obvious symptoms. The American Diabetes Association recommends that all women be screened for gestational diabetes between the 24th and 28th week of pregnancy, or sooner if you have a history of gestational diabetes or other risk factors.

Screenings include:

  • Blood glucose test - A sweet, specially prepared glucose mixture is swallowed. One hour later, a blood sample is taken and tested to determine how much glucose is still present. If your blood glucose level is above 140 mg/dl (milligrams per deciliter), your doctor will recommend a glucose tolerance test.
  • Glucose tolerance test - You follow a special diet for three days, then fast for eight hours. Before you are permitted to eat or drink anything, a blood sample is taken and tested. A glucose drink is consumed, and a blood sample is taken every hour for three hours. If your blood glucose is in the abnormal range, gestational diabetes is diagnosed.

What If I Already Have Diabetes?

Women with pre-existing diabetes used to be warned against pregnancy because they were more likely to have a baby with birth defects. Today, with careful planning and preconception care, diabetic women have as much chance as non-diabetic women of having a problem-free pregnancy and a healthy baby.

Pregnancy can, however, worsen some long-term diabetes complications. Before stopping birth control, it's a good idea to have the following evaluations:

  • An eye exam
  • Kidney function test, which involves providing a blood and/or urine sample
  • Blood pressure reading
  • Pelvic exam
  • Assessment for heart disease
  • Hemoglobin A1c test (a blood test that shows whether your blood sugar has been normal over the past three to four months). If the hemoglobin A1c value is very high when you get pregnant, your baby has an increased chance of a birth defect when born.

Need To Know:

Discuss your pregnancy plans with your doctor. He or she will probably recommend prenatal vitamins, especially folic acid, which reduces the risk of certain birth defects.

Need To Know:

Women with type 2 diabetes who take oral medications to help control their condition need to switch to insulin during pregnancy and breast feeding. These medications can be passed from the mother to the baby through the placenta and breast milk, and may harm the baby. Insulin does not cross the placenta.

 

 
 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.